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493 Normal Maternal Body Mass Index is Associated with Good Perimatal Outcome in Postdates Patients
410
SPO Abstracts
January 1992 Am J Obstet Gynecol
492
THE USE OF THE NONSTRESS TEST AND THE FETAL BIOPHYSICAL PROFILE IN THE EXPECTANT MANAGEMENT OF PATIENTS WITH PROLONGED PRETERMPREMATURERUPTUREOFTHEMEMBRANES. G.O. Del Valle, G.M. Joffe, J.F. Smith, G.J. Gilson, L.A. Izquierdo, o. Kushnir, M.S. Chatterjee, L. Papile', and L.B. Curet, Dept. of OB/GYN, University of New Mexico, Albuquerque, NM The role of the nonstress test and the fetal biophysical profile in the management of prolonged preterm PROM was evaluated in 68 consecutive patients who had a latency period of more than 48 hours. Fetal surveillance consisted of daily nonstress tests and biophysical profiles every two to three days. Patients were delivered due to spontaneous labor, clinical chorioamnionitis, fetal distress, or upon reaching 37 weeks gestation. We found a statistically significant association between an abnormal nonstress test and overall infectious complications (chorioamnionitis plus neonatal infections), neonatal infections (sepsis and pneumonia), and fetal distress. A biophysical profile score ::;'6 was associated with fetal distress, as was the combination of absent fetal breathing movements and nonreactive nonstress test. The association between a low biophysical profile (::;.6) or the combination of absent fetal breathing movements plus a nonreactive NST and the development of chorioamnionitis or neonatal infectious complications did not reach statistical significance. This study suggests a role for the use of the NST in the management of patients with prolonged preterm PROM, but is less encouraging in terms of defining a role for the biophysical profile as the main tool for fetal surveillance in cases of prolonged preterm PROM.
494
DOES UNEXPLAINED SECOND-TRIMESTER MATERNAL SERUM HUMAN CHORIONIC GONADOTROPIN ELEVATION PREDICT PERINATAL COMPLICATIONS? R. Gonen MD.', R. Perez BSc.', M. David PhD" H. Dar PhDx, M. Sharf MD.' Departments of Obstetrics & Gynecology and Genetics, Bnai Zion Hospital, Faculty of Medicine, Tehnion, Haifa, Israel. This cohort analytic study was undertaken in order to examine whether women with unexplained human chorionic gonadotropin (HCG) elevation at 16 to 20 weeks gestation are at increased risk for perinatal complications as has been shown for women with unexplained elevation of malernal serum alpha-feto prolein (MSAFP). We searched the data base of our laboratory for all cases of unexplained HCG levels > 2.5 MOM (with normal MSAFP) during the year 1990. We then assessed the delivery records of these patients for various maternal and perinatal complications and compared lhem to a group of randomly selected controls whose HCG as well as MSAFP were normal. Delivery records were available for 262 (91 %) patients wilh elevated HCG and 265 (92%) of the controls. Elevated HCG was found to be associated with a significantly increased risk for IUGR - odds ratio 2.75 (95% CI 1.08 - 7.02) and for hypertension - odds ratio 4.35 (95% CI 1.88 - 10.06). The risk for the various perinatal complications was computed with multiple logistic regression to adjust for the effects of risk factors such as maternal age and obstetrical history. The risks associated wilh high HCG were unchanged by adjuslment for these factors. We conclude that women with unexplained elevated HCG are at increased risk for hypertension and IUGR.
493
IIORIW. MATERNAL BIllY !lASS IIIlEX IS ASSOCIATED IIITH GIXII PERINATAL x WTCIIIE II POSTDATES PATIENTS. c. O'Reilly-Green , M. Divon, Albert Einstein College of Medicine, Bronx, NY. 80dy mass index (8MI), defined as weight divided by height
495
AMNIOTIC FLUID INDEX (AFI) AS A PREDICTOR OF LATENCY AFTER PRE-TERM PROM William MacMillan. M.D .. Stephanie Mann M.D.x, Susan Shmoys, M.D. and Daniel Saltzman, M.D. Department of Obstetrics and Gynecology Suny-Stony Brook, Stony Brook, New York Patient records were reviewed to identify patients admitted with a diagnosis of pre-term PROM. 51 patients with initial evaluation within 48 hours of rupture and gestational age 26-34 weeks were identified. AFI was evaluated along with a Biophysical Profile, these were followed serially until delivery. Delivery was accomplished because of spontaneous labor, chorioamnionitis or fetal compromise. Tocolytics were not used. AFI at initial evaluation was stratified into 3 groups: Low (AFI<5), Reduced (5.0-7.9) and Normal (>8.0). Latency in days from PROM to delivery was evaluated for these groups. A significant (P
squared, is used as a measure of obesity. Various reconmendations have been made regarding the optimal
pregnancy weight gain. However, paucity of data exists regarding the optimal 8MI in pregnancy. Purpose: To evaluate the association between pregnancy Postdates outcome in postdates patients and maternal BMI. patients are interesting in this regard because IUGR and macrosomia can be studied after the exclusion of hypertension and diabetes. The BMI was evaluated prospectively in 158 postdates patients (over 41 weeks by accurate dates). An adjusted BMI (aBMI) was calculated by subtracting the maternal mass attributable to pregnancy from the caLcuLated BMI and was correLated with the incidence of CIS, macrosomia, small for gestationaL age (SGA), ol i gohydrarrni os, low Apgar score at 5 minutes, acidosis and NICU adnission. A normal a8MI was defined 2 as less than 23.5 Kg/m . Results:
Cesarean section Macrosomia Small for gestational age (wt <2800gm) 01 i gohydramni os low Apgar or pH N!CU adnisslon
I I I I I I I
Normal a8M! 1/27 0/27 2/27 5/24 0/24 0/24
High a8M! 53/131 26/131 5/131 32/127 16/127 5/127
p value .0006 .03 NS NS NS NS
In conclusion, normal maternal weight for height (aBMI) in postdates pregnancy is associated with a lower incidence of cesarean section and macrosomia. NormaL a8MI is not associated with increased perinatal morbidity despite the fact that this group contains individuaLs who may actual Ly be underweight.
SPO Abstracts
January 1992 Am J Obstet Gynecol
492
THE USE OF THE NONSTRESS TEST AND THE FETAL BIOPHYSICAL PROFILE IN THE EXPECTANT MANAGEMENT OF PATIENTS WITH PROLONGED PRETERMPREMATURERUPTUREOFTHEMEMBRANES. G.O. Del Valle, G.M. Joffe, J.F. Smith, G.J. Gilson, L.A. Izquierdo, o. Kushnir, M.S. Chatterjee, L. Papile', and L.B. Curet, Dept. of OB/GYN, University of New Mexico, Albuquerque, NM The role of the nonstress test and the fetal biophysical profile in the management of prolonged preterm PROM was evaluated in 68 consecutive patients who had a latency period of more than 48 hours. Fetal surveillance consisted of daily nonstress tests and biophysical profiles every two to three days. Patients were delivered due to spontaneous labor, clinical chorioamnionitis, fetal distress, or upon reaching 37 weeks gestation. We found a statistically significant association between an abnormal nonstress test and overall infectious complications (chorioamnionitis plus neonatal infections), neonatal infections (sepsis and pneumonia), and fetal distress. A biophysical profile score ::;'6 was associated with fetal distress, as was the combination of absent fetal breathing movements and nonreactive nonstress test. The association between a low biophysical profile (::;.6) or the combination of absent fetal breathing movements plus a nonreactive NST and the development of chorioamnionitis or neonatal infectious complications did not reach statistical significance. This study suggests a role for the use of the NST in the management of patients with prolonged preterm PROM, but is less encouraging in terms of defining a role for the biophysical profile as the main tool for fetal surveillance in cases of prolonged preterm PROM.
494
DOES UNEXPLAINED SECOND-TRIMESTER MATERNAL SERUM HUMAN CHORIONIC GONADOTROPIN ELEVATION PREDICT PERINATAL COMPLICATIONS? R. Gonen MD.', R. Perez BSc.', M. David PhD" H. Dar PhDx, M. Sharf MD.' Departments of Obstetrics & Gynecology and Genetics, Bnai Zion Hospital, Faculty of Medicine, Tehnion, Haifa, Israel. This cohort analytic study was undertaken in order to examine whether women with unexplained human chorionic gonadotropin (HCG) elevation at 16 to 20 weeks gestation are at increased risk for perinatal complications as has been shown for women with unexplained elevation of malernal serum alpha-feto prolein (MSAFP). We searched the data base of our laboratory for all cases of unexplained HCG levels > 2.5 MOM (with normal MSAFP) during the year 1990. We then assessed the delivery records of these patients for various maternal and perinatal complications and compared lhem to a group of randomly selected controls whose HCG as well as MSAFP were normal. Delivery records were available for 262 (91 %) patients wilh elevated HCG and 265 (92%) of the controls. Elevated HCG was found to be associated with a significantly increased risk for IUGR - odds ratio 2.75 (95% CI 1.08 - 7.02) and for hypertension - odds ratio 4.35 (95% CI 1.88 - 10.06). The risk for the various perinatal complications was computed with multiple logistic regression to adjust for the effects of risk factors such as maternal age and obstetrical history. The risks associated wilh high HCG were unchanged by adjuslment for these factors. We conclude that women with unexplained elevated HCG are at increased risk for hypertension and IUGR.
493
IIORIW. MATERNAL BIllY !lASS IIIlEX IS ASSOCIATED IIITH GIXII PERINATAL x WTCIIIE II POSTDATES PATIENTS. c. O'Reilly-Green , M. Divon, Albert Einstein College of Medicine, Bronx, NY. 80dy mass index (8MI), defined as weight divided by height
495
AMNIOTIC FLUID INDEX (AFI) AS A PREDICTOR OF LATENCY AFTER PRE-TERM PROM William MacMillan. M.D .. Stephanie Mann M.D.x, Susan Shmoys, M.D. and Daniel Saltzman, M.D. Department of Obstetrics and Gynecology Suny-Stony Brook, Stony Brook, New York Patient records were reviewed to identify patients admitted with a diagnosis of pre-term PROM. 51 patients with initial evaluation within 48 hours of rupture and gestational age 26-34 weeks were identified. AFI was evaluated along with a Biophysical Profile, these were followed serially until delivery. Delivery was accomplished because of spontaneous labor, chorioamnionitis or fetal compromise. Tocolytics were not used. AFI at initial evaluation was stratified into 3 groups: Low (AFI<5), Reduced (5.0-7.9) and Normal (>8.0). Latency in days from PROM to delivery was evaluated for these groups. A significant (P
squared, is used as a measure of obesity. Various reconmendations have been made regarding the optimal
pregnancy weight gain. However, paucity of data exists regarding the optimal 8MI in pregnancy. Purpose: To evaluate the association between pregnancy Postdates outcome in postdates patients and maternal BMI. patients are interesting in this regard because IUGR and macrosomia can be studied after the exclusion of hypertension and diabetes. The BMI was evaluated prospectively in 158 postdates patients (over 41 weeks by accurate dates). An adjusted BMI (aBMI) was calculated by subtracting the maternal mass attributable to pregnancy from the caLcuLated BMI and was correLated with the incidence of CIS, macrosomia, small for gestationaL age (SGA), ol i gohydrarrni os, low Apgar score at 5 minutes, acidosis and NICU adnission. A normal a8MI was defined 2 as less than 23.5 Kg/m . Results:
Cesarean section Macrosomia Small for gestational age (wt <2800gm) 01 i gohydramni os low Apgar or pH N!CU adnisslon
I I I I I I I
Normal a8M! 1/27 0/27 2/27 5/24 0/24 0/24
High a8M! 53/131 26/131 5/131 32/127 16/127 5/127
p value .0006 .03 NS NS NS NS
In conclusion, normal maternal weight for height (aBMI) in postdates pregnancy is associated with a lower incidence of cesarean section and macrosomia. NormaL a8MI is not associated with increased perinatal morbidity despite the fact that this group contains individuaLs who may actual Ly be underweight.